reseArcH reFlections
Finding research to answer patients’ questions
by Dawn Stacey, Marie-Cecile Domecq, Freya Crawley and Joelle Doucet
earching for research study articles
may seem daunting given the vast
array of articles. Furthermore, some
articles have limited access making it
more difficult to obtain the full article. The purpose of this paper is to: a)
demonstrate a series of six steps to find
a research study in PubMed to answer
questions patients ask; and b) explore
ways to link to other relevant articles
within PubMed.
Scenario Part I:
Mrs. F. is a 45-year-old woman who completed treatments for stage II breast cancer
three months ago. Today at her follow-up
visit, she tells you that she is still feeling a
lot of fatigue. She asks you whether yoga
will make her feel less tired.
You do not know the answer to her question and your initial desire is to say that it
would not hurt. You ask other health professionals in the clinic: some think it could
make the fatigue worse and others think
it may help. However, no one referred to
research to answer the question.
Rather than give Mrs. F. an uninformed and vague response, you decide to
find an answer to the question by conducting an online search for research studies.
ABout tHe AutHors
The following six steps illustrate how to
find an answer to a research question.
Step 1: Identify the research question
Does yoga decrease fatigue in breast
cancer survivors?
Step 2: List Keywords and synonyms
What are the keywords in the
research question and synonyms? For
• yoga/exercise/stretching
• fatigue/feeling tired/tiredness/low
• breast cancer/breast malignancy
• survivor/survivorship
Step 3: Go to PubMed
Open PubMed directly at http://ncbi.
nlm.nih.gov/pubmed or find “PubMed
Central” using your preferred search
engine (e.g. Google). PubMed provides
a link to more than 24 million articles
that are focused on biomedical literature (e.g. MEDLINE, life science, online
books). It is free of charge for anyone to
use. If available, PubMed will provide
the abstract as a brief description of the
article. Commonly PubMed will link to
the full-text of articles with some articles available free of charge and others
having limited access.
Step 4: Conduct an advanced search
Given there are usually several keywords, click on the “Advanced” search
option, located under the search box at
the top of the webpage. Start with the
original set of keywords to see if you
can find relevant articles to help answer
your question. On the first line and each
subsequent line, change “All Fields” to
For example, add ‘yoga’; then, on
the second line add ‘fatigue’; on the
third line add ‘cancer’; on the fourth
line add ‘breast’; and finally add “survivor” (Figure 1). The findings reveal a list
of articles that include all of these keywords in the title and/or the abstract.
Review the titles of the articles found
to determine if any are relevant to your
research question.
If there are not enough articles, a)
remove one or two of the key words and
re-run the search; or b) exchange one of
the keywords for a synonym. When we
removed “survivor” in the example, we
identified more than 1 article.
Step 5: Read article titles to see if one or
more answer the question
In the centre of the screen, browse
the results by reading the titles of the
articles (Figure 2). If there is a relevant
Dawn Stacey, RN, PhD, Professor, School of
Nursing, University of Ottawa, Scientist, Ottawa
Hospital Research Institute
[email protected]
Marie-Cecile Domecq, Librarian, Health Sciences
Library, University of Ottawa
[email protected]
Freya Crawley, Fourth year nursing student,
School of Nursing, University of Ottawa
[email protected]
Joelle Doucet, Second year nursing student, School
of Nursing, University of Ottawa
[email protected]
Figure 1: Conduct an Advanced Search (Step 4)
1. Select the “Title/ Abstract” search option to focus the results
2. Add keywords
3. Run your search
After reading the abstract, your
research question may be answered
and this particular article is labelled as
a Free PMC (PubMed Central) Article.
Located in the upper right-hand side of
the webpage you will find a link to get
free access to the paper. According to
Bower and colleagues, when women
survivors of breast cancer used yoga
for three months, they had less severe
fatigue, improved vigour, felt less
depressed, and were less stressed.
Step 6: Look at related citations
When the abstract is open in
PubMed, there are links to many other
potentially better resources (Figure 3).
The “Cited by Systematic Reviews” tab
on the right-hand side of the webpage
provides you with evidence from similar
studies that have been combined into a
single article. For example,
• “Yoga for breast cancer patients and
survivors: A systematic review and
meta-analysis” by H. Cramer and colleagues in 2012 reported that several
studies suggest that yoga can be recommended to improve psychological
health during breast cancer treatment.
• “Effects of yoga interventions on
fatigue in cancer patients and survivors: A systematic review of randomized controlled trials” by J. Sadja and
Figure 2: Read article titles to see if one or more answers the
question (Step 5)
(Note: the number and order of results may change over time
as PubMed is constantly adding new articles to the database)
1. Most recent articles first
2. Other relevant articles based on the title
3. Free full-text articles from the PubMed collection
P.J. Mills in 2013 reported that several studies suggest that yoga may be
beneficial for reducing cancer-related
fatigue in women with breast cancer.
Scenario Part II:
You telephone Mrs. F. at home to tell her
that you found out that several studies
reported that yoga reduced cancer-related
fatigue in women with breast cancer. For
example, in one study the severity of fatigue
decreased after three months of yoga, and
women felt less depressed and less stressed.
In this article, we demonstrated how
a simple set of six steps can be used to
find research studies to answer questions patients may ask. For more details
on using PubMed, go to the PubMed
Quick Start Guide on the homepage.
Figure 3: Read the abstract and access the paper (Step 5) and
Look at related citations (Step 6)
1. Access to full text. Choose the free one!
2. This article has been cited by more recent articles or systematic reviews published in PubMed. Worth looking at!
3. PubMed suggested “related” articles. It may be an excellent
way to discover new articles.
Canadian Oncology Nursing Journal • Volume 25, Issue 3, Summer 2015
Revue canadienne de soins infirmiers en oncologie
title, click on the title to access the
abstract that briefly describes the article.
For example, there is one article on the
second page titled:
• “Yoga for persistent fatigue in breast
cancer survivors: A randomized controlled trial” written by J.E. Bower and
colleagues in 2012